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Professionalism in the Health Sciences

Definitions, rights, and responsibilities

This document defines a profession and discusses the rights, responsibilities, and privileges associated with health care professionals. All health professions aim for the highest standards of professionalism. But the level of achievement of that ideal varies from profession to profession. Society expects an adherence to standards of professionalism and, in return, the public grants the health professions certain privileges.

A frequently asked question is: "What do you do for a living?" In many jobs, what a person "does" is used to define the person. In a profession, it is more appropriate to ask: "Who is doing the work?"

A "profession" is much more than a job; rather, it is a learned vocation. Flexner (1915), a prominent medical educator, along with others, presented various criteria that a work group must possess to acquire 'professional status.' Today a number of recognized professions exist, and a number of newer and older health care professional groups continue to develop toward professional status recognition. The following criteria for defining a profession and are to be considered the ideal; or they may represent the working goals of still-developing professional groups. They are:

The activities of the work group must be "intellectual" and based on a "theory of practice." Most health professional groups have one or more theories of practice and a stated Code of Ethics.

Intellectual activities can be learned by others and that these "teachable techniques are the work of professional education." Most health professions require certain levels of educational performance in the general and biomedical sciences before progression into practice in clinical sites and laboratories where professional program component takes place.

The activities of the working group must be "practical, as opposed to purely academic or intellectual". Health professionals are facilitators and doers. The skills that are learned demand application to real problems.

There must be a "strong internal organization of members" of the work group. All professions have one or more professional organizations or associations to which members may or may be required to belong.

The "motivating force for workers is altruism," the desire to provide for the good of society. Generally, however, this is expressed by the more specific desire of helping the individual. Many health professions require contact with individuals, clients, or patients as a major component of the practice of that profession.

From a practical viewpoint, professionals are also distinguished by lay persons via one or more of the following credentialing systems: (1) being awarded a specialized degree by an accredited institution; (2) passing a specialized examination; (3) possessing a license to practice; and/or (4) being admitted to a qualifying association.

There are several general characteristics and associated responsibilities of being a health care professional:

Being a member of a profession requires education, training, and supervised experience above the usual level. In most health professions, this is accomplished in post-baccalaureate professional programs. As a part of the professional program, this includes acquiring of a theoretical body of knowledge, based on good science that relates to the theory of practice. Admission to post-baccalaureate professional programs requires superior performance and demonstration of professional potential at previous levels. At some stage in the educational process, selection from larger pool of applicants ensures that only the better applicants are admitted into the professional program. Professional programs are selective, but selection is made on the basis of qualifications and not the ability to pay for it.

Being a member of a profession demands strict adherence to the ethical standards of the profession and professional conduct according to the recognized Codes of Ethics of the profession. Acceptance of ethical code must be within the scope of a person's personal code. An expectation of honesty and integrity is assumed. Individuals for which there is the slightest indication of dishonest activity are not admitted to the professional program. Individuals within the profession who violate the code of honesty can be removed. Since many health care professionals have access to controlled substances and otherwise illegal drugs, many of the health care professions will not admit any applicant who has a record of illegal drug use or abuse.

A professional in practice agrees that personal opinions are subordinate to the ethical code even when these are in conflict. It is expected that individuals of the profession live by a high ethical code in their private and public lives and expect others in the profession to do the same. The profession is enhanced when the overall standards of the profession are raised and enforced. Professional censure and a loss of professional privileges may be applied to those who fail to follow the ethical code. Serious offenses can be cause to remove individuals from being able to practice the profession.

Members of a profession maintain a primary dedication to a high standard of professional and community service to the public without undue attention to self. Professionals promote the educational advancement of others in the arts and sciences with the belief that such promotion enhances the betterment of the community. Pre-professional students often mistakenly think they somehow will "acquire" a public service mandate only after graduation. Professional schools will look for continuing evidence of community service and involvement as an important factor in the admission of a student to the professional program. Public service should be motivated by the desire of the applicant to serve others, rather than an act to meet a requirement for admission into a professional program.

In their social contract with society, health professionals are granted the right of self-government of the regulatory aspects of their profession. These responsibilities include setting up standards of practice that are determined by professional peers. Individual professional performance, in relation to standards, is monitored by the professional peer group. Group associations of professionals usually carry out the function and are responsible for policing their own ranks. As members of a profession, each individual assumes the responsibility for the welfare of the profession.

The enforcement of professional and ethical standards of professional conduct is usually formalized into the laws of states by requiring professionals to practice under a "license" granted by the state. Requiring a license to practice allows the profession to effectively police their own ranks. Licensure also places the authority of law in determining the minimum educational preparation for professional activity. Licensure prevents a person who is not qualified to practice the profession. Licensure also can be used to enforce violations of the ethical codes through a revoking of the license to practice.

(From the 2002 Keynote Address at the National Association of Advisors for the Health Professions (NAAHP) by Robert F. Sabalis.) Once licensed, health professionals enjoy "one of the best seats in the house to observe the human condition". They hear patients' secrets. They prescribe toxic substances. They undress and touch people. They remove bodily organs. They relate to people in their most vulnerable moments. They participate in the beginning and the end of life. They discuss matters of life and death. They do all of this in exchange for significant autonomy and financial support for their education, research, clinical activities, and for the promise to practice in accord with professional codes.

Other privileges, rights, and responsibilities of being a health care professional:

Professionals have the rights to keep professional knowledge and skills updated in a changing world. This includes the rights and responsibilities to have access to continuing education. Continuing educational opportunities are often sponsored and approved by professional societies in cooperation with colleges and universities. In many professions, a minimum number of hours or credits of continuing education in a set period of time may be required for continued licensure renewals.

Professionals have the right to attain the tangible benefits and monetary rewards that represent a partial return on a long educational investment. This achievement earns high respect that offers the professional and their families the ability for involvement and taking on leadership roles in the service activities of the community. In several of the health professions, a residency period up to several years may be required in which continuing professional practice experience is required and gained under conditions of reduced monetary return.

Professionals have the right to indicate the achievement of different levels of professional standards by the use of various "post titles" after their name. These may include indicators of educational, recognition, specialty or skill achievements.

For some professions having the highest investment of preparation and selectivity, achieving professional status offers the right to the courtesy and respect indicated by the use of the title of "Dr.", rather than the standard Mr. or Ms.

Professionals have the responsibility to behave in a manner in the community that does not lower the esteem of the profession of which he or she is a member. The level of anonymity and the expected standard of behavior in public differ among professions and may be influenced by other roles that the individual professional may have in society that may increase notoriety.

Professionals are expected to adhere to the standards of behavior agreed upon by the group. The specifics differ from profession to profession and may change over time. For example, most professions guide professionals to refrain from criticizing other colleagues in the profession who have violated a standard of behavior in public, but then place obligations for them to do so in private. In some health and medical professions, it is agreed that the practitioners shall follow the norms for advertising one's practice. Handing out business cards may be acceptable, but advertising in the newspaper may not be considered to be acceptable.

In a market-driven economy concerned about health cost containment, health care professionals set standards for performance that value "quality of care" over "cost of care". In most situations it is the responsibility of the professional to inform the client of other options that would benefit the client, not withholding discussions of any options of treatment and not withholding professional advice on the options best for the client. Several business health groups prohibit their health professional employees from providing certain health information if not asked, and there is increasing controversy as to whether the health professional has the right or responsibility to advise a patient in situations where the patient does not ask for advice. The motivating force of the business health group, in promoting inexpensive options, is cost containment, not patient welfare. Many health professional organizations are concerned about effects on the erosion of the standards of professionalism in cases where professionals are offered monetary incentives for not advising patients into options that would result in greater cost to the business health organization under which the health professional operates.

What relationship does professionalism have to admission into health professional programs?

All professionals are experts, but not all experts are professionals (Fishbein 2003). In addition to technical skills, a consideration of "the person" behind the admission scores, along with the GPA, are of paramount importance in the admission selection process. Each profession is characterized by having practitioners expressing a common core of professional attributes that are characteristic of professionals. Other attributes tend to be innate in those who tend to seek entry into specific programs. Still other attributes are desired and may be enhanced through training. The admissions officers of health professional programs evaluate students in each of these categories. No applicant will possess the ideal combination of all that admissions officers are seeking. However, it is easier for them to select applicants with more of these attributes than it is to attempt to develop these attributes in training. The lesson to student applicants is clear. To become a competitive applicant one needs: (1) to understand the attributes of the practitioners in the profession and match these to their own; and (2) to work to improve any weak personal attributes that are important in the practice of the profession.

A cliche is that there is a "right person for the right job." The common problem of many health profession applicants is that they have not investigated the people and workings of the health profession enough to know what attributes are needed and how their personal attributes compare. The factors that motivate an applicant toward a particular profession often turn out to be rather shallow upon inquiry. Here are two examples:

"I really enjoy watching the program CSI and want to become a forensic scientist."

"I want to go into medicine because I really enjoy the respect that doctors have compared to lawyers."

An applicant who has thoroughly investigated a health profession ought to be able to express the desire to enter a profession because they possess or have developed the personal attributes required in the profession. For an exercise in personal and professional attribute assessment, download the Professional and Personal Attribute Comparison Sheet and complete the exercise that is described.